Provider First Line Business Practice Location Address:
116 E PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-765-6579
Provider Business Practice Location Address Fax Number:
814-765-6570
Provider Enumeration Date:
09/14/2006